The Effect of Cumulative Anticholinergic Use on the Cognitive Function of Older Adults: Results from the Personality and Total Health (PATH) Through Life Study

Neelamegam, Malinee; Zgibor, Janice C.; Chen, Henian; O’Rourke, Kathleen; Bakour, Chighaf; Rajaram, Lakshminarayan; Anstey, Kaarin J.

doi:10.1093/gerona/glaa145

Cited by 12 publications

(11 citation statements)

References 42 publications

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“…However, anticholinergic medication, as quantified by the Anticholinergic Drug Scale or the Anticholinergic Risk Scale was significantly associated with major preexisting NCD [12 ▪▪ ]. This confirms recent findings that long-term intake of anticholinergics is associated with poorer cognitive and physical functioning in a general, nonsurgical, population [14,15].…”

Section: Medicationsupporting

confidence: 85%

Risk assessment of perioperative neurocognitive disorders, where are we now?

Soehle

Coburn

2022

Current Opinion in Anaesthesiology

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Purpose of reviewPerioperative neurocognitive disorders (PNDs) are among the most frequent complications after surgery and are associated with considerable morbidity and mortality. We analysed the recent literature regarding risk assessment of PND. Recent findingsCertain genetic variants of the cholinergic receptor muscarinic 2 and 4, as well as a marked degree of frailty but not the kind of anaesthesia (general or spinal) are associated with the risk to develop postoperative delirium (POD). Models predict POD with a discriminative power, for example, area under the receiver operating characteristics curve between 0.52 and 0.94.

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Section: Medicationsupporting

confidence: 85%

Risk assessment of perioperative neurocognitive disorders, where are we now?

Soehle

Coburn

2022

Current Opinion in Anaesthesiology

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“…The levels of LTCI certification have been shown to be highly correlated with the Barthel Index (Spearman’s ρ= −0.86) and moderately correlated with Mini-Mental State Examination (MMSE) scores (Spearman’s ρ= −0.42) [ 20 ]. We defined functional disability as the onset of long-term care needs at support level 1 or above [ 21 , 22 ].…”

Section: Methodsmentioning

confidence: 99%

Potential utility of physical function measures to improve the risk prediction of functional disability in community-dwelling older Japanese adults: a prospective study

et al. 2021

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Background While gait speed, one-leg standing balance, and handgrip strength have been shown to be independent predictors for functional disability, it is unclear whether such simple measures of physical function contribute to improved risk prediction of functional disability in older adults. Methods A total of 1,591 adults aged ≥ 65 years and without functional disability at baseline were followed up for up to 7.9 years. Functional disability was identified using the database of Japan’s Long-term Care Insurance System. Maximum gait speed, one-leg standing time, and handgrip strength were measured at baseline. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) for the association of physical function and functional disability incidence. The incremental predictive value of each physical function measure for risk prediction was quantified using the difference in overall C-statistic, category-free net reclassification improvement (NRI), and integrated discrimination improvement (IDI) index. Results During follow-up (median: 7.8 years), functional disability was identified in 384 participants. All of the physical function measures were inversely associated with the risk of functional disability, independent of potential confounding factors. The multivariable adjusted HRs (95 % CIs) for functional disability per one standard deviation increment of maximum gait speed, one-leg-standing time, and hand grip strength were 0.73 (0.65–0.83), 0.68 (0.59–0.79), and 0.72 (0.59–0.86), respectively. Incorporation of each of maximum gait speed, one-leg-stand time, and hand grip strength into a basic model with other risk factors significantly improved C-statistic from 0.770 (95 % CIs, 0.751–0.794) to 0.778 (0.759–0.803), 0.782 (0.760–0.805), and 0.775 (0.756–0.800), respectively (all p < 0.05). A model including all three measures had the highest C-statistic of 0.787 (0.765–0.810). The improvements in risk prediction were also confirmed by category-free NRI and IDI index. Conclusions Adding any of the three measures to a basic model with other known risk factors significantly improved the prediction of functional disability and addition of all three measures provided further improvement of the prediction in older Japanese adults. These data provide robust evidence to support the practical utility of incorporating these simple physical function measures into functional disability risk prediction tools.

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“…When measured this way, studies of AChB and cognitive ability often produce discordant results 16 . There are reports of positive associations between anticholinergic use and executive function 12,[18][19][20][21] , associative learning 22 , visual- 23 , episodic- 24,25 , and short-term memory 26 , delayed and immediate recall 27 , language abilities 28 , visuospatial skills 28 , attention 28 , and reaction time 28 . However, some authors have found no evidence for delayed and immediate recall 21,22,28,29 , reaction time 22 , executive function 23,27 , language abilities 27,29 , working memory 25,27 , processing speed 25 , and implicit- 28 and semantic 25 memory.…”

Section: Introductionmentioning

confidence: 99%

“…There are reports of positive associations between anticholinergic use and executive function 12,[18][19][20][21] , associative learning 22 , visual- 23 , episodic- 24,25 , and short-term memory 26 , delayed and immediate recall 27 , language abilities 28 , visuospatial skills 28 , attention 28 , and reaction time 28 . However, some authors have found no evidence for delayed and immediate recall 21,22,28,29 , reaction time 22 , executive function 23,27 , language abilities 27,29 , working memory 25,27 , processing speed 25 , and implicit- 28 and semantic 25 memory. Additionally, because anticholinergic scales sometimes include different drugs and score the same drugs differently, they could represent another source of variation in reported findings.…”

Section: Introductionmentioning

confidence: 99%

Anticholinergic burden in middle and older age is associated with lower cognitive function, but not with brain atrophy

Mur

Marioni

Russ

et al. 2022

Preprint

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Anticholinergic drugs block muscarinic receptors in the body. They are commonly prescribed for a variety of indications and their use has previously been associated with dementia and cognitive decline. In UK Biobank participants with linked health-care records (n=163,043, aged 40-71 at baseline), for about 17,000 of which MRI data was available, we calculated the total anticholinergic drug burden according to 15 different anticholinergic scales and due to different classes of drugs. We then used linear regression to explore the associations between anticholinergic burden and various measures of cognition and structural MRI, including general cognitive ability, 9 separate cognitive domains, brain atrophy, volumes of 68 cortical and 14 subcortical areas, and fractional anisotropy and median diffusivity of 25 white-matter tracts. Anticholinergic burden was modestly associated with poorer cognition across most anticholinergic scales and cognitive tests (7/9 FDR-adjusted significant associations, standardised betas (β) range: -0.039, -0.003). When using the anticholinergic scale exhibiting the strongest association with cognitive functions, anticholinergic burden due to most classes of drugs exhibited negative associations with cognitive function, with β-lactam antibiotics (β=-0.035, pFDR<0.001) and opioids (β=-0.026, pFDR<0.001) exhibiting the strongest effects. Anticholinergic burden was not associated with any measure of brain macro- or microstructure (pFDR>0.08). Anticholinergic burden is weakly associated with poorer cognition, but there is little evidence for associations with brain structure. Future studies might focus more broadly on polypharmacy or more narrowly on distinct drug classes, instead of using purported anticholinergic action to study the effects of drugs on cognitive ability.

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The Effect of Cumulative Anticholinergic Use on the Cognitive Function of Older Adults: Results from the Personality and Total Health (PATH) Through Life Study

Cited by 12 publications

References 42 publications

Risk assessment of perioperative neurocognitive disorders, where are we now?

Risk assessment of perioperative neurocognitive disorders, where are we now?

Potential utility of physical function measures to improve the risk prediction of functional disability in community-dwelling older Japanese adults: a prospective study

Anticholinergic burden in middle and older age is associated with lower cognitive function, but not with brain atrophy

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